Wk 16: Maternal/Fetal Uterotonics

Question 1

Pharmacologic C-Section goals:

-Stable _____________
-Limiting cardiac and respiratory _________ drugs that ______ the ________
-Birth of a _______ baby
-Minimizing __________

Answer 1

Hemodynamics
depressant, cross, placenta
healthy
bleeding

Question 2

Physiologic changes during pregnancy and delivery:

Pregnancy results in changes in maternal ______ and _______

Answer 2

anatomy and physiology

Question 3

Physiologic changes during pregnancy and delivery:

-Increased maternal _________ demands
-__________ alterations from the fetus
-Mechanical effects of an _________ uterus

Answer 3

metabolic
Biochemical
enlarging

Question 4

Pregnancy-induced changes in the cardiovascular system include:
-________ blood volume
-________ cardiac output
-_________ vascular resistance
-Supine ___________

Answer 4

Increased
Increased
Decreased
hypotension

Question 5

Physiologic changes in pregnancy

MAC of volatile anesthetics (increase/decreases)?

Answer 5

Decreases (-40%)

Question 6

Physiologic changes in pregnancy

FRC
HCO3
PaCO2

Increase or decrease?

Answer 6

Decrease

Question 7

Physiologic changes in pregnancy

PaO2
RR
Oxygen consumption
TV
Minute ventilation

Increase or decrease?

Answer 7

Increase

Question 8

Physiologic changes in pregnancy

Hemoglobin
Clotting factors

Increase or decrease?

Answer 8

Increase

Question 9

Physiologic changes in pregnancy

GFR

Increases or decreases?

Answer 9

Increases

Question 10

With increases in plasma volume, a reduction in maternal ______ _______ concentration is noted

Answer 10

plasma protein

Question 11

Maternal intravascular fluid volume begins to increase in the ______ trimester of pregnancy as the result of increased production of _____, _______, and ________, which together promote sodium absorption and water retention

These changes are likely induced by ________

Answer 11

first
renin
angiotensin
aldosterone

progesterone

Question 12

______ ______ mass lags behind the increase in plasma volume
-Maternal hemoglobin usually remains at ___g/dL or greater even at term
-Lower values at any time during pregnancy represent _______

Answer 12

Red cell
11
anemia

Question 13

By term gestation, the plasma volume increases approximately ___%, and the red cell volume increases about ___%

Answer 13

50
25

Question 14

______ _____ mass lags behind the increase in _______ volume
-Maternal hemoglobin normally remains at ___g/dL or greater even at term
-Lower values at any time during pregnancy represent ________

Answer 14

Red cell
plasma
11
anemia

Question 15

The physiologic _______ of pregnancy does not cause a reduction in ________ delivery because of a coincident increase in ______ _____

Answer 15

anemia
oxygen
cardiac output

Question 16

The additional intravascular fluid volume (_____ to ______mL at term) compensates for an average ____ to _____ mL blood loss with vaginal delivery and _____ to _____ mL estimated blood loss with cesarean section

Answer 16

1,000 to 1,500 mL
300 to 500 mL
800 to 1000 mL

Question 17

Following delivery, uterine contraction ___________ blood, compensating for the acute blood loss

Answer 17

autotransfuses

Question 17

Mild __________ is often noted
-Platelet count does not usually drop below ________ microL and is not associated with abnormal ________

Answer 17

thrombocytopenia
70,000
bleeding

Question 17

Gestational thrombocytopenia is thought to result from a combination of __________ and __________ ________ ________

Answer 17

hemodilution
accelerated platelet turnover

Question 18

Mild __________ unrelated to infection is common during pregnancy

These changes revert to normal during the ______ after delivery

Answer 18

leukocytosis
week

Question 19

In spite of mild thrombocytopenia, pregnancy is a __________ state with ______ clotting and ________ in fibrinolytic capacity

Answer 19

hypercoagulable
increased
decrease

Question 20

Thrombogenic factors such as factors _____, _____, _____, and _____ ______ factor, and __________ are increased

_______ and ________ are decreased

Answer 20

VII (7), VIII (8), X (10), von Willebrand factor, fibrinogen

protein S
antithrombin III

Question 21

Must plan strategies for increased risk of venous thromboembolism; _____, etc.

Answer 21

SCD’s

Question 22

What happens to PT, PTT during pregnancy?

Answer 22

20% decrease

Question 23

What happens to D-dimer levels during pregnancy?

Answer 23

Increase

Question 24

*Uterine blood flow increases progressively during pregnancy from about ____ mL/min in the nonpregnant state to _____ mL/min (about ___% of cardiac output) at term gestation*

Answer 24

100 mL/min 700 mL/min 10%

Question 25

Uterine and placental blood flows are dependent on maternal ______ _______ and are directly related to uterine ________ ________

Answer 25

cardiac output perfusion pressure

Question 26

Decreased uterine perfusion pressure can result from: -Maternal ________ secondary to ________ -_________ compression -Decreased _______ ______ from either general or neuraxial anesthesia

Answer 26

hypotension hypovolemia Aortocaval systemic resistance

Question 27

Increased uterine ______ pressure can also decrease uterine perfusion -The _______ positioning with vena caval compression -Frequent/prolonged uterine _______ -Significant/prolonged ________ musculature contraction (Valsalva) during pushing

Answer 27

venous supine contractions abdominal

Question 28

Extreme hypocapnia (PaCO2 < 20 mmHg) associated with __________ secondary to labor ______ can reduce uterine blood flow with resultant fetal ________ and _______

Answer 28

hyperventilation pain hypoxemia, acidosis

Question 29

*Neuraxial blockade does NOT alter uterine blood flow in the absence of _______ _______*

Answer 29

Maternal hypotension (OK as long as maintain BP in 20% of baseline)

Question 30

Endogenous maternal _________ and exogenous _______ may cause an increase in uterine arterial resistance and a decrease in uterine _______ _______, depending on the type and dose given

Answer 30

catecholamines vasopressors blood flow

Question 31

Historically,________ was the drug of choice -Early studies showed it had no effect on uterine blood flow despite drug-induced increases in maternal arterial blood pressure, whereas other vasopressors resulted in ________ and fetal ________

Answer 31

ephedrine vasoconstriction acidosis

Question 32

*Newer studies showed the use of ________ is not only effective in preventing hypotension but also is associated with less fetal ______ and base ______ than the use of ephedrine*

Answer 32

phenylephrine acidosis deficit

Question 33

More recently, trials have investigated the utility of _________ infusion to prevent maternal hypotension -Early results show that phenylephrine and _______ were equally effective -More data is needed prior to changing clinical practice recommendations

Answer 33

norepinephrine norepinephrine

Question 34

*Obstetric hemorrhage has a high incidence of _________ observed relative to ______ _______ ______ when comparing against other surgical or traumatic hemorrhage* This is believed to be _________, but is not completely understood

Answer 34

coagulopathy total blood loss multifactorial

Question 35

Obstetric hemorrhage The active consumption of ________ factors may contribute as the placenta and uterus separate

Answer 35

procoagulant

Question 36

Obstetric hemorrhage Increased __________ and ________ activation have been observed, along with release of ______ _______ into the blood stream (this further activates consumption of procoagulant factors)

Answer 36

fibrinolysis platelet tissue factor

Question 37

Obstetric hemorrhage __________ ( ____) and __________ ________ (________) are more representative of in vivo coagulation than standard laboratory tests and are increasingly being used in the management of obstetric hemorrhage and hemostatic disorders

Answer 37

Thromboelastograph (TEG) rotational thromboelastometry (ROTEM)

Question 38

*Oxytocin stimulates ________ ________ and is administered to ______ labor at term, reduce and prevent uterine _______, and decrease ________ in the postpartum or postabortion period*

Answer 38

uterine muscle induce atony hemorrhage

Question 39

Oxytocin By stimulating ______ ______ uterine contraction, blood loss at the site of placental attachment is reduced

Answer 39

smooth muscle

Question 40

Oxytocin To prevent uterine atony administration of ____ to ____ units of oxytocin over ___ seconds is recommended _________ is sometimes needed to treat hypotension

Answer 40

1 to 3 30 sec phenylephrine

Question 41

Oxytocin To manage uterine atony and postpartum hemorrhage, ___ to ___ international unit of IV oxytocin is recommended

Answer 41

3 to 5

Question 42

*Prior oxytocin exposure promotes oxytocin receptor ________ and ________ and may be a risk factor for postpartum hemorrhage and uterine atony*

Answer 42

downregulation desensitization

Question 43

Oxytocin MOA: Binds to oxytocin receptors in ________, increasing intracellular ____ and stimulating uterine _________

Answer 43

myometrium calcium contractions

Question 44

Oxytocin metabolism, excretion

Answer 44

Plasma Liver Urine

Question 45

Oxytocin half life

Answer 45

1-6 minutes (why need infusion)

Question 46

Oxytocin dose _____-____ units mixed in ___L of ____

Answer 46

20-60 1 LR

Question 47

Methylergonovine (Methergine) MOA: Increases uterine contraction _____ and ______

Answer 47

force frequency

Question 48

Methylergonovine (Methergine) metabolism, excretion

Answer 48

Liver Urine

Question 49

Methylergonovine (Methergine) half life

Answer 49

3.4 hours

Question 50

Methylergonovine (Methergine) dose

Answer 50

0.2 mg IM

Question 51

Methylergonovine (Methergine) caution/contraindication

Answer 51

HTN preeclampsia

Question 52

Carboprost (Hemabate) MOA: Stimulates _____ _____ and uterine _______ (synthetic _______)

Answer 52

smooth muscle contractions prostaglandin

Question 53

Carboprost (Hemabate) metabolism, excretion

Answer 53

Liver, lung Urine

Question 54

Carboprost (Hemabate) dose

Answer 54

250 mcg IM

Question 55

Carboprost (Hemabate) caution/contraindication

Answer 55

Asthma

Question 56

Misoprostol (Cytotec) MOA: Produces uterine _______ ( _________ E1)

Answer 56

contractions prostaglandin

Question 57

Misoprostol (Cytotec) metabolism, excretion

Answer 57

Gut parietal cells, CYP450 Urine

Question 58

Misoprostol (Cytotec) half life

Answer 58

20-40 minutes

Question 59

Misoprostol (Cytotec) dose

Answer 59

1000 mcg PR